VISWA LAB CORPORATION

8423 Almeda Road, Suite `S'

Houston, Texas 77054, USA

FUEL INFORMATION FORM

Chief Engineer: Please fill out this form and fax it to Viswa Lab on

[phone] when shipping samples.

CUSTOMER NAME:	SHIP NAME:
PORT AND DATE OF BUNKERING:	SUPPLIER AND FUEL GRADE:
BUNKER INFO QUANTITY: ____________ MTons DENSITY: ____________ kg/m³ @ 15°C VISCOSITY: ____________ cSt @ 50°C	SEAL NO SHIP: ______________ SUPPLIER: ______________ LAB: ______________
REMARKS :

NOTE: PLEASE ATTACH A COPY OF BUNKER RECEIPT, SUPPLIED BY THE BUNKER SUPPLIER. IF ANY OF THE ABOVE INFORMATION IS AVAILABLE ON BUNKER RECEIPT, YOU NEED NOT REPEAT IT ON THIS FORM.

(SAMPLE TO BE DISPATCHED TO VISWA LAB)

DATE HANDED OVER: _______________________

AGENT RESPONSIBLE FOR DISPATCH: ____________________________________________________

CITY/COUNTRY: _________________________________________

TELEPHONE: ________________________ FAX: _____________________________________

COURIER SERVICE:

FEDEX

DHL

OTHER:

________________________________

AIR WAYBILL / PACKAGE TRACKING # (IMPORTANT): ____________________________________

CHIEF ENGINEER'S NAME: _____________________________________________________

Issued: Mar-2002

Tel:	USA [phone]
Fax:	USA [phone]
Email:	[e-mail]
Web:	http://www.viswalab.com

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